Atrial fibrillation: which patients should be managed in primary, secondary and tertiary care?

2010 ◽  
Vol 3 (1) ◽  
pp. 19
Author(s):  
David Jones ◽  
Tom Wong ◽  
Diana Gorog ◽  
Vias Markides
Keyword(s):  
Atrial Fibrillation ◽  
Tertiary Care

scholarly journals TO STUDY THE PREVALENCE AND CLINICAL PROFILE OF CHRONIC ATRIAL FIBRILLATION IN HOSPITALIZED PATIENTS

2014 ◽  
Vol 04 (02) ◽  
pp. 017-020
Author(s):  
Dharma Rao V. ◽  
Rajaneesh Reddy M. ◽  
Srikanth K. ◽  
Raj Kumar Prakash B. ◽  
Satya Prasad A. ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Chronic Atrial Fibrillation ◽  
Hospitalized Patients ◽  
Clinical Profile ◽  
Female Dominance ◽  
Elderly Age ◽  
Female Ratio

Abstract: Objective: To determine the prevalence of chronic atrial fibrillation (AF) in a tertiary care center and to identify the clinical profile of chronic AF in hospitalized patients. Methods: All patients admitted to Mamata General Hospital in medicine/cardiology wards with chronic AF (persistent and permanent) during the period January 2012 to December 2012 were included into the study. The principal exclusion criteria were new onset AF and acute AF. Results: During the study period, 49 patients were admitted with chronic AF with an average of 45.44 years. A slight female dominance was seen with male: female ratio of 1:1.2. Half of the patients (51%) were below the age 50 years. The elderly age group comprised of only 16.3% of cases. The commonest presenting complaint was dyspnea followed by palpitation. Rheumatic valvular heart disease was seen more commonly in people below the age of 50 years whereas hypertension and ischemic heart disease after 50 years. Heart failure was the commonest condition associated with the chronic AF and was the cause of hospitalization in almost fifty percent of cases Conclusion: Chronic AF is still a cause of concern in India in people below the age of 50 years due to high prevalence of rheumatic fever inspite of advances in the medical field.

scholarly journals The clinical and etiological profile of atrial fibrillation after echocardiography in a tertiary care centre from North India - a cross sectional observational study

2017 ◽  
Vol 5 (3) ◽  
pp. 847 ◽  
Author(s):  
Ranvijay Singh ◽  
Rajesh Kashyap ◽  
Rajeev Bhardwaj ◽  
Rajeev Marwaha ◽  
Manish Thakur ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Tertiary Care ◽  
Hypertensive Heart Disease ◽  
Atrial Appendage ◽  
North India ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. In western countries, rheumatic heart disease (RHD) is a rare cause of atrial fibrillation but in developing countries like India it is one of the commonest cause of atrial fibrillation. We studied etiology, left atrial size and the incidence of left atrial appendage clot in patients with atrial fibrillation at our institution so that guidelines could be formulated to manage the patients of AF in the hours of emergency.Methods: 110 consecutive patients of atrial fibrillation coming to emergency, cardiology and medicine outpatient department over a period of one year were enrolled for the study. Ethical committee clearance was taken. Detailed history were taken, clinical presentation reviewed  and examination were carried out. All patients were subjected to transthoracic echocardiography and for transesophageal echocardiography if required.Results: The mean age of patients in the study was 58.42±14.27 years (range 22-90 years). Maximum numbers of patients were in the age group of 61-70 years (26.37%). Out of 110 patients with atrial fibrillation, 72 patients (65.46%) were females and 38 patients (34.54%) were males. Majority of patients presented with more than one symptom. Out of 110, 66 patients (60%) had RHD. Among RHD patients, 50 patients (45.55%) were females and 16 patients (14.55%) were males. Next common causes were hypertensive heart disease and degenerative valvular heart disease.Conclusions: In our study RHD was the most common cause of atrial fibrillation, followed by hypertensive heart disease and degenerative valvular heart disease. Mitral valve involvement was seen in all patients of RHD. Left atrial enlargement was seen in majority of patients, so left atrial enlargement could be a predictor of atrial fibrillation. Patients of left atrial enlargement are more prone to develop left atrial appendage clot.

scholarly journals Impact of Anticoagulation Clinic Intervention on Patient Centred Outcomes in a Tertiary Care Hospital

2020 ◽  
Author(s):  
S Sunil Kumar ◽  
Oliver Joel Gona ◽  
Nagaraj Desai ◽  
B Shyam Prasad Shetty ◽  
KS Poornima ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Therapeutic Range ◽  
Tertiary Care ◽  
Anticoagulation Clinic ◽  
Care Hospital ◽  
Thromboembolic Events ◽  
Co Morbidity

Introduction: Vitamin K Antagonists (VKAs) have been in use for more than 50 years. They have remained as mainstay therapy in the prevention of thromboembolic events in atrial fibrillation, mechanical heart valves and venous thromboembolism. Despite many years of clinical experience with VKAs, the quality of anticoagulation achieved in routine clinical practice is suboptimal. Aim: To study the effects of structured Anticoagulation Clinic (ACC) interventions on patient centred outcomes in subjects taking VKAs. Materials and Methods: A retrospective study was conducted among patients taking VKAs enrolled in ACC. A total of 169 patients receiving VKAs for at least six months with 4 INR (International Normalised Ratio) values and completed 12 months of follow-up were analysed. Anticoagulation related quality measures like Time in the Therapeutic Range (TTR), Percentage of International Normalised Ratios in the therapeutic Range (PINRR) and clinical outcomes like stroke, systemic embolic events and bleeding was analysed at the time of enrolment and compared with those during ACC care. Results: Among 352 patients enrolled in ACC, 169 patients were eligible for analysis. The mean age of the study population was 55.62±13.77 years. Atrial fibrillation (59%) was the most common indication for VKA therapy. Hypertension (66.3%) was the most common co-morbidity. Mean TTRs were significantly higher in the ACC care when compared with the pre-ACC care at 12 months follow-up (77.58±8.85% vs 51.01±16.7%, p<0.0001). There was a significant improvement in TTRs as early as three months of ACC intervention (73.18±13.56%). At the time of enrolment, 21.9% of patients had individual TTRs (i-TTR) >70% which increased to 70.4% at 12 months of follow-up. INR testing was done more frequently in ACC care. Adverse clinical events were higher in pre-ACC care than ACC care (4.7% vs 2.4%, p>0.05). Major bleeding and thromboembolic events were higher in pre-ACC care than ACC care (1.8% vs. 0.6% and 2.4% vs. 0.6% respectively). Conclusion: ACC services helps in achieving better quality of anticoagulation control as measured by time in therapeutic range translating into better clinical outcomes.

Abstract 9395: The Clinical Role of Atrial Fibrillation in Patients with Arrhythmogenic Right Ventricular Dysplasia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ardan M Saguner ◽  
Samuel Baldinger ◽  
Argelia Medeiros-Domingo ◽  
Sabrina Ganahl ◽  
Felix C Tanner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Right Ventricular ◽  
Cardiac Death ◽  
Task Force ◽  
Tertiary Care ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Right Atrial ◽  
Clinical Role ◽  
Right Ventricular Dysplasia ◽  
Increased Risk

Introduction: Atrial fibrillation/flutter (Afib/Aflu) in general, and clinical variables predicting Afib/Aflu in particular, are not well defined in patients with arrhythmogenic right ventricular dysplasia (ARVD). Hypothesis: We hypothesized that transthoracic echocardiography (TTE) and ECG could be helpful to predict Afib/Aflu in these patients. Methods and Results: 12-lead ECGs and TTEs of 90 patients from three tertiary-care centers diagnosed with definite or borderline ARVD according to the 2010 Task Force Criteria were analyzed. Data were compared in two patient groups: (1) patients with Afib/Aflu and (2) all other patients. Eighteen (20%) patients experienced Afib/Aflu during a follow-up period of 5.8 years (interquartile range 2.0-10.4 years). Kaplan-Meier analysis (Figure) revealed reduced times to Afib/Aflu among patients with echocardiographic RV fractional area change <27% (p<0.001), left atrial diameter ≥24.4 mm/m2 (p=0.001), and right atrial short axis diameter ≥22.1 mm/m2 (p=0.05). From all ECG variables, P sinistroatriale conferred the highest hazard ratio (3.37, 95% CI 0.92-12.36, p=0.067). Five patients with Afib/Aflu experienced inappropriate ICD shocks compared to four patients without Afib/Aflu (36% vs. 9%, p=0.03). Presence of Afib/Aflu was more prevalent in heart transplanted patients and in those who succumbed to cardiac death compared to the remaining patients (56% vs. 16%, p=0.014). Conclusions: Afib/Aflu are associated with inappropriate ICD shocks, heart transplantation, and cardiac death in patients with ARVD. Echocardiographic evidence of reduced RV function and atrial dilation helps to identify those ARVD patients being at increased risk for Afib/Aflu, which may help to guide individual patient management.

Abstract 16766: Intraprocedural Ablation and Fluid Status Management in Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sahitya Allam ◽  
Evan Harmon ◽  
Sula Mazimba ◽  
James M Mangrum ◽  
Ilana Kutinsky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tertiary Care ◽  
Fluid Management ◽  
Management Strategies ◽  
Clinical Trial Data ◽  
Posterior Wall ◽  
Fluid Status ◽  
Volume Output

Background: Recent randomized clinical trial data has supported catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). Ablation and fluid management strategies could impact periprocedural outcomes especially in HF patients. Methods: We conducted a single-center retrospective analysis of 200 consecutive patients with and without HF undergoing CA at a tertiary care academic center from July 2017 through June 2018. HF was defined as any EF < 40%, prior inpatient admission for HF exacerbation, or ambulatory management of HF confirmed by independent chart review. Diuretic regimens were reported as furosemide equivalent. Results: Among 200 patients, 65 (32.5%) had HF and 135 (67.5%) did not. HF patients had longer mean procedure times (299.8 ± 96 min vs 268.4 ± 96 min, p = 0.03) and were more likely to require mitral isthmus (p < 0.001), posterior wall isolation (p = 0.002), and cavotriscupid isthmus (p = 0.004) ablations. There were no differences between the HF vs. non-HF groups’ intraprocedural volume intake, intraprocedural volume output, net fluid status, or intraprocedural diuretic dose (Table 1). HF patients received higher doses of IV (41.5 ± 43.0 mg vs 23.6 ± 11.8 mg, p = 0.007) and PO (43.2 ± 16.7 mg vs 26.7 ± 10.0 mg, p < 0.001) postprocedural diuretic. There were no differences in the rates of major in-hospital complications (Table 1). In a multivariable regression analysis adjusted for procedural covariates, there were higher proportions of posterior wall isolation (p = 0.01) as well as postprocedural PO (p = 0.01) and IV diuretic (p = 0.002) administration in the HF cohort. Conclusion: Intraprocedural volume and diuretic management was similar between HF and non-HF patients undergoing CA of AF, though HF patients tended to receive more aggressive diuresis post procedurally with no difference in complications. Table 1. Intra- and post-procedural management and outcomes in HF vs non-HF patients undergoing CA for AF

scholarly journals A study of the clinical profile of atrial fibrillation in a tertiary care super-specialty referral centre in Central Nepal

2013 ◽  
Vol 8 (3) ◽  
pp. 9-16
Author(s):  
MP Gautam ◽  
S Gautam ◽  
S Guru Prasad ◽  
G Subramanyam ◽  
U Ghimire
Keyword(s):  
Atrial Fibrillation ◽  
Tertiary Care ◽  
Clinical History ◽  
Airway Disease ◽  
Chronic Obstructive ◽  
Medical Sciences ◽  
Lone Atrial Fibrillation ◽  
Common Cause ◽  
Echocardiographic Study ◽  
Surface Ecg

Background The conventional causes and risk factors for atrial fibrillation (AF) are somewhat arbitrary; overlap exists, multiple aetiologies are often present in one individual, and clinical presentation is non- specific. This study was an attempt to study the clinical and echocardiographic profile of patients with AF in a tertiary care super-specialty hospital of a developing country. Materials and Methods This study was conducted in College of Medical Sciences, Chitwan, Nepal throughout the year 2010. Subjects with AF, diagnosed based on clinical history, medical records and surface ECG, were included in the study. The presentation, types and causes of AF and structural as well as functional abnormalities were assessed. Results A total of 136 consecutive subjects were included in the study. The mean age was 42.40 (20.48) years ranging from 17 to 80 years. Majority of the AF subjects were female (54.41%). Among symptomatic cases, palpitation was the most common (23.53%) presentation followed by dyspnea (17.65%) and stroke or transient ischemic attack (15.44%). Asymptomatic presentation was also not uncommon (25%). Persistent AF was the most common form (31.62%). Rheumatic heart disease was the most common cause (33.09%) followed by lone atrial fibrillation (23.52%), coronary artery disease (16.18%), hypertension (8.82%) and thyrotoxicosis (7.35%). Other causes included chronic obstructive airway disease (5.88%), diabetes (2.94%), cardiomyopathy (1.47%), constrictive pericarditis (1.47%), myocarditis (0.74%) and infective endocarditis (0.74%). Nearly 65 % subjects had either structural or functional abnormalities in echocardiographic study; dilated left atrium was the most prevalent abnormality. Conclusion In contrast to the studies reported from developed nations, our subjects with AF were younger and female, the most common cause was RHD and the majority had either structural or functional abnormalities in echocardiographic study. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-3, 9-16 DOI: http://dx.doi.org/10.3126/jcmsn.v8i3.8679

Propafenone-Induced Liver Injury

1992 ◽  
Vol 26 (7-8) ◽  
pp. 926-928 ◽  
Author(s):  
Sarah A. Spinier ◽  
Cheryl A. Elder ◽  
K. Elizabeth Kindwall
Keyword(s):  
Atrial Fibrillation ◽  
Liver Injury ◽  
Liver Function ◽  
Care Center ◽  
Tertiary Care ◽  
Liver Function Tests ◽  
Tertiary Care Center ◽  
Upper Limit ◽  
Function Tests ◽  
Recurrent Atrial Fibrillation

OBJECTIVE: To describe propafenone-induced liver injury. DESIGN: Retrospective case report. SETTING: Referred care in a large tertiary care center. Laboratory tests were performed at the auxiliary site and the tertiary care center. PATIENT: A 71-year-old woman with atrial fibrillation developed elevations of greater than two times the upper limit of normal in alkaline phosphatase (ALK), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyltransferase (GGT) after initiation of propafenone therapy. INTERVENTIONS: Studies included serial measurements of ALK, ALT, AST, and GGT. RESULTS: The patient developed elevations of greater than two times the upper limit of normal in ALK, ALT, and AST, one month after initiating propafenone therapy. The propafenone dose was decreased from 900 to 675 mg/d and, ten days later, the ALK, ALT, and AST were decreased slightly, but still above the upper limit of normal. One month later, serum transaminases had returned to baseline, but propafenone therapy was discontinued because of recurrent atrial fibrillation, persistent elevation in ALK, and elevation in GGT. Two months after discontinuing propafenone, serum aminotransaminase and ALK concentrations had normalized and GGT had decreased and remained only slightly elevated. CONCLUSIONS: The occurrence of liver injury secondary to propafenone therapy is rare. Reported cases appear to be secondary to hepatocellular injury, cholestasis, or a combination of the two. In this case, the pattern demonstrated by elevations in liver enzymes may be classified as acute cholestatic liver injury. Because the reported incidence is 0.1–0.2 percent and there are no known fatalities secondary to propafenone liver injury, routine monitoring of liver function tests in all patients receiving propafenone cannot be recommended at this time. Baseline liver function tests prior to initiating propafenone therapy with follow-up laboratory studies one month later are recommended in patients with known liver dysfunction. If elevations are noted, a reduction in dose may result in lower liver enzyme concentrations, although discontinuation of therapy may be required in some cases.

scholarly journals Scraping up CHA2DS2-VASc - defining components of the acronym in a nationwide registry study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
E Kouki ◽  
O Halminen ◽  
J Haukka ◽  
M Linna ◽  
P Mustonen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Primary Care ◽  
Health Care ◽  
Risk Score ◽  
Tertiary Care ◽  
Personal Identification ◽  
Hospital District ◽  
Total Prevalence ◽  
Icd 10

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital district Finnish foundation for cardiovascular research Introduction Atrial fibrillation (AF) is a major cause of ischemic stroke. The risk of stroke is strongly associated with age, sex and comorbidities of the patients. Therefore, it is crucial that the comorbidities are consistently recorded in medical records as well as health care registries. Purpose This study aims to evaluate the prevalence of the comorbidities related to AF stroke risk in Finnish nationwide population registries, and assess how the use and combination of these registries affect the calculated CHA2DS2-VASc risk score. The comorbidities evaluated were Hypertension, Diabetes, Stroke or TIA, Heart Failure, and Vascular Disease. Methods The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study collected data on all Finnish AF patients from 1st January 2004 to 31st December 2018. Due to the initiation of the national primary care register in 2012, this substudy uses the data of patients with a new AF diagnosis during 2012-2018 (n = 168 353). Using a unique personal identification code, individual patient data were linked from the Finnish national health care registries "AvoHILMO" (primary care) and "HILMO" (secondary and tertiary care), National Prescription Register (ATC codes of purchased medication) and the National Reimbursement Register for reimbursed medication upheld by the Social Insurance Institute (KELA). Results The average CHA2DS2-VASc risk score when entering the cohort, and including information from all registries, equaled 2.91 for men (mean age 70.0 years) and 4.42 for women (mean age 76.9 years). The highest prevalence of diabetes and hypertension were found based on the National Reimbursement Register (ATC codes). Stroke or TIA and heart failure were identified almost exclusively based on secondary and tertiary hospital records. The table represents our results.  Conclusion Comprehensive registry analysis of AF patients requires the inclusion of both hospital and medication data. The role of primary care information was limited. Comorbidity and CHA2DS2-VASc weight Total Prevalence Primary care ICD-10 codes Primary care ICPC-2 codes Secondary and tertiary care ICD-10 codes ATCcodes Medication reimbursement codes Hypertension 1 82%137 317 28%47 337 13%21 427 39%66 252 77%130 400 7%10 957 Diabetes 1 24%41 017 13%22 666 13%22 547 14%23 793 21%35 942 12%20 295 Stroke or TIA 2 17%28 653 4%6 254 1%1 968 16%27 379 - - Heart Failure 1 18%29 827 5%7 630 1%1 398 16%26 366 - 1%1 908 Vascular Disease1 28%47 420 12%19 581 2%3 265 25%41 647 - 7%11 802 Average CHA2DS2-VASc contribution 1.86 0.65 0.31 1.26 0.99 0.26 The prevalence of the comorbidities and average CHA2DS2-VASc risk score contribution by registry and combined.

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